From Pathology to Progress: The Evolution of Transgender Mental Healthcare

Ever wonder how far we've come in understanding transgender mental health? The journey from pathologization to progress has been long and challenging, but knowing this history is essential for appreciating our present and building a better future.

The Band Brothers Mental Health Podcast dives into the origins of transgender mental healthcare, tracing its evolution from the 19th century—when trans folks were misunderstood, labeled as homosexuals, and institutionalized—to today's more affirming approaches. This eye-opening exploration reveals how pioneering figures like Magnus Hirschfeld and Harry Benjamin began distinguishing transgender identities from sexual orientation, setting the stage for gradual improvements in understanding and care.

We reveal the significant shifts in medical perspectives, from the first formal diagnosis of "Psychopathia Transsexualialis" in 1949 to the inclusion of "transsexualism" in diagnostic manuals in the 1980s, and finally to the revolutionary change in the DSM-5 in 2013 that focused on gender dysphoria rather than pathologizing identity itself. 

If we don't know where we have been, how far we have come, we will become discouraged and fall into despair. This episode offers a crucial historical perspective while emphasizing the importance of continued advocacy. The work isn't finished, but by understanding our collective journey, we can draw strength from those who persevered before us. Subscribe now to join a community committed to improving the mental health and support for Black transmen and Black transmasculine folks, because knowing our history empowers our future.

• DSM:  Diagnostic and Statistical Manual of Mental Disorders
• DCD: Disorders of Sexual Development
• ICD:  International Classification of Diseases
• Reference:  Psychiatry.org - Gender Dysphoria Diagnosis

Chapters

• 0:00 Introducing Banner Brothers Podcast
• 2:30 Podcast Purpose and Resources
• 3:14 Origin Story of Trans Mental Health
• 4:08 Early History and Timeline Definitions
• 5:17 Evolution of Diagnosis 1950s-2013
• 8:00 Finding Hope in Our History

Transcript

Solomon: 0:10

Welcome to the Band of Brothers Mental Health Podcast, with a focus on the mental health and well-being of Black transmasc, transmen and Black trans joy. The podcast is a mix of solo episodes focused on improving the mental health and well-being of Black transmasc and trans men, interviews with Black transmasc and trans men sharing their mental health journey, tips for improving their mental health and well-being, their mental health struggles and how they are overcoming them. And also interviews with mental health professionals, therapists, community, overcoming them. And also introduce mental health professionals, therapists, community health workers and organizations trained and focused on gender and mental health care. The podcast was started because 60% of young black trans men consider suicide, according to a research study by the Trevor Project, and 45% of black trans men consider suicide, according to the Williams Institute. When I'm questioned or receive pushback for just focusing on black transmasc and trans men, I cite these two statistics. The podcast will also talk about the importance of peer support groups like Band of Brothers to foster mental health and well-being through social support for black transmasc/ men and what that would look like. The podcast encourages getting gender-affirming, professional mental health care from a licensed, gender-affirming mental health therapist and participate in peer support groups like Band of Brothers. The podcast does not provide mental health care nor diagnosis. The podcast does not provide mental health care nor diagnosis. The podcast does not condone ostracizing nor isolating those who are diagnosed and or suffer from any form of mental health conditions. The podcast strives to be a saving, healing space. The podcast is educational and provides tips and resources to improve mental health and wellness. The topics the podcast covers may be triggering. Therefore listen at your own discretion. If you are suicidal or suffering from suicidal ideation, call Trans Lifeline, 877-565-8860. Black Line, 800-604-5841. Thrive Lifeline, which you can text at 313-662-8209. Thrive Lifeline, which you can text at 313-662-8209, and. Or the Travel Project, 866-488-7396. Hey, welcome to the Banner Brothers Mental Health Podcast Focus on the mental health and well-being of Black trans masculine folks and Black trans men. I'm Solomon, your host, and today I'm diving into the origin story of trans mental health. But before I dive in, I want to give a shout out to listeners in ATL, Philly, vegas, smithfield, virginia, washington, virginia, boardman, oregon, austin, texas, albany and Brooklyn, new York and Germany. Thank you for your support. Spread the word and share the podcast with other Black Transmasculine folks and Black Trans men.

Solomon: 3:14

It is important to know beginnings and origins, where the fight began and why it started. Trans mental health did not have a good origin, nor beginning. Mental institutions, prison or invisibility was the solution for those who were diagnosed and lived as a trans person. However, through social change based on advocacy, caused by the introduction of new ideas and ideologies that challenge the existing norms of each time period, in each timeline transgender, diverse folks were less pathologized and stigmatized. The battle still raises in the present. However, I am thankful for the progress of the process. I'm going to discuss the timeline of Transgender Health and the issues during each time period, the Transmental Health and the Issues during each time period, but first I'm going to define some terms before I dive in and reference the source for the timeline. It will be in the show notes as well.

Solomon: 4:11

DSM means Diagnostic and Statistical Manual of Mental Disorders. DSD means Disorders of Sexual Development. ICD means international classification of diseases and the reference is Psychiatry. org Gender Dysphoria Diagnosis. The first timeline is 19th, the early 20th century. Trans folks were misunderstood, thought to be homosexuals and pathologized. Magnus Hirschfeld was credited as among one of the first physicians to distinguish between same-sex attraction and transsexualism. The next timeline is the 1950s through the 1960s. In 1949, david Carl Will Cohen won the earliest diagnosis related to gender identity Psychopathia Transsexualialis. In 1966, harry Benjamin MD published his book the Transsexual Phenomena and is credited with popularizing the term transsexual as used today, educating medical professionals about transphobes and pioneering her own treatments to facilitate gender transition.

Solomon: 5:27

The next timeline is the 1980s through the 1990s. The diagnosis of transsexualism first appeared in the publication of DSM-III in 1980. In 1990, the World Health Organization followed and included this diagnosis in ICD-10. With the release of DCM-4 in 1994, transsexualism was replaced with gender identity disorder in adults and adolescents in an effort to reduce stigma. However, controversy continued, with advocates and some psychiatrists pointed to ways in which this diagnostic category pathologized identity rather than a true disorder. The last timeline is 2013.

Solomon: 6:15

The publication of DSM-5 in 2013 eliminated gender identity disorder and replaced it with gender dysphoria. This change further focused the diagnosis on the gender identity-related distress that some trans folks experience and for which they may seek psychiatric, medical and surgical treatments, rather than on individual trans folks' identity themselves. The DSM-5 exclusively states gender nonconformity is not in itself a mental disorder. The fifth edition also includes a separate gender disorder in children's diagnosis and, for the first time, allows the diagnosis to be given to intersex folks. Dsd. Dsm-5 also includes the optional post-transition specifier to indicate when a particular trans person's gender transition is complete. In this post-transition case, the diagnosis of gender dysphoria would no longer apply, but the trans person may still need ongoing medical care, such as HRT or gender-affirming surgeries. Ongoing medical care, such as HRT or gender-affirming surgeries. However, discussions continue among advocates and medical professionals about how best to preserve access to gender-affirming care while also further decreasing the stigma diagnostic care categories placed on trans and gender-diverse folks.

Solomon: 7:41

Though Trans Mental Health got off to a rocky start, you hear through each timeline how the mental health care of trans folks improved over time and how mental health professionals' ideas about trans folks changed. I want you to come away from this episode with a piece of our history, a history that is not openly talked about. I want you to research some of the things talked about in this episode. If we don't know where we have been, how far we have come, we will become discouraged and fall into despair. Part of our mental health journey is understanding the obstacles that we face before us and that, if those before us endure and persevere to make things better not only for themselves during that time, but to also make it better for those in the future timeline and us in the present timeline, though it is still much work to do. Change can happen and has happened. Let each of us continue to do the work.

Solomon: 8:39

This is Solomon signing off. Don't forget to check out the show notes for the definitions and reference I talked about. If you found this helpful, subscribe, follow, share, recommend and financially support the podcast. Thank you for listening. The Band of Brothers Medall Podcast is produced, written and edited by Trans Men in Search of Media in Atlanta, georgia. Sound design also created by Trans Men in Search of Media channel.